With the in­ter­im analy­sis for its Phase II Duchenne mus­cu­lar dy­s­tro­phy, lit­tle Capri­cor Ther­a­peu­tics was mere­ly look­ing for a guide­post, a sig­nal, a trend that the ef­fects seen in an ear­li­er tri­al can be repli­cat­ed with a new dos­ing reg­i­men and de­liv­ery method. In­stead, the biotech found it­self blessed with a bas­ket of da­ta points that seem to buck the nat­ur­al his­to­ry trend and sep­a­rate the drug from place­bo in a sta­tis­ti­cal­ly sig­nif­i­cant way, more than dou­bling its tiny stock $CAPR in pre-mar­ket trad­ing.

Lin­da Mar­bán Capri­cor

The pri­ma­ry end­point for the HOPE-2 tri­al is PUL 2.0, a mea­sure of up­per limb func­tion and one of sev­er­al ways Capri­cor quan­ti­fied skele­tal mus­cle im­prove­ment. Ex­ecs al­so spot­light­ed pul­monary and car­diac ben­e­fits in the top-line re­sults — fac­tors that are par­tic­u­lar­ly for the pa­tient pop­u­la­tion that they are tar­get­ing, who tend to be old­er and non-am­bu­la­to­ry.

Con­sist­ing of prog­en­i­tor cells de­rived from donor hearts, CAP-1002 is de­signed to re­lease ex­o­somes that kick off a cy­cle of mus­cle re­pair by sup­press­ing in­flam­ma­tion and dri­ving im­munomod­u­la­tion.

Cur­rent­ly, a num­ber of DMD pa­tients take glu­co­cor­ti­cos­teroids for that pur­pose, in­clud­ing pred­nisone and de­flaza­cort (sold in the US by Marathon as Em­flaza). There’s al­so Sarep­ta’s ex­on-skip­ping drug, eteplirsen (Ex­ondys 51), though its ben­e­fits have yet to be borne out; Sarep­ta and a hand­ful of ri­vals are now in hot pur­suit of a sup­posed one-time cure to re­place the miss­ing dy­s­trophin gene in pa­tients.

“While there had been ad­vances in gene ther­a­py, we be­lieve that con­trol­ling in­flam­ma­tion over and above what can be done by steroids is im­por­tant,” CEO Lin­da Mar­bán said in a con­fer­ence call.

Her hus­band, Ed­uar­do Mar­bán, had de­vel­oped the tech at Johns Hop­kins.

Da­ta from the small, place­bo-con­trolled study sug­gest that with a high­er dose than the past and de­liv­ered in­tra­venous­ly, the ther­a­py is work­ing. At the six-month cut, 6 pa­tients were evalu­able in each arm. For those treat­ed with CAP1002 mid-lev­el PUL — think mov­ing el­bows and pulling hand to mouth — de­te­ri­o­rat­ed by an av­er­age of 0.2 on a 6-point scale, com­pared to 0.8 on place­bo. The p-val­ue was 0.0389.

This and grip strength are the on­ly im­prove­ments still sta­tis­ti­cal­ly sig­nif­i­cant af­ter six months (there was al­so a three-month snap­shot), but Capri­cor stressed pos­i­tive trends through­out.

“I’d like to just re­mind peo­ple that this pop­u­la­tion of DMD re­al­ly rep­re­sents more than half of all DMD pa­tients and there re­al­ly have not been ther­a­pies that have re­al­ly fo­cused on this pop­u­la­tion which have just in­cred­i­bly high bur­den of dis­ease,” Craig Mc­Don­ald, the na­tion­al PI and a pro­fes­sor at UC Davis, said in the call.

On the key is­sue of safe­ty, Capri­cor not­ed that there had on­ly been one se­ri­ous ad­verse event among 30 in­fu­sions af­ter it put a stan­dard pre-med­ica­tion reg­i­men in place to mit­i­gate po­ten­tial im­mune re­ac­tions. Two pa­tients had had im­me­di­ate im­mune re­ac­tions to the treat­ment late last year, which prompt­ed the com­pa­ny to put a vol­un­tary hold on the tri­al.

Armed with these num­bers and an RMAT des­ig­na­tion from the FDA, Capri­cor is now look­ing in­to a “lean, ef­fi­cient” piv­otal study to po­si­tion the cell ther­a­py for a BLA — if it can find the cash to do so.

A few months ago it was forced to chop 21 staffers, or half of its work­force, in or­der to car­ry on with clin­i­cal ac­tiv­i­ties un­til the end of this year.

So­cial im­age: Shut­ter­stock

At the end of January, the European Medicines Agency officially launched its new clinical trials info system (CTIS), although the migration to the new platform has only really just begun, and sponsors have until the end of January 2023 before all initial trial applications must be submitted through CTIS.

Overall, 56 clinical trial applications have been submitted in CTIS during the first 3 months since the launch of the system on Jan. 31, according to new data posted by the EMA. By comparison, about 4,000 new trials are authorized each year across Europe.

As concerns related to uptake and distribution continue to linger, Switzerland is among the first countries that plans to destroy hundreds of thousands of expired and unused Covid-19 vaccine doses.

The European country said it plans to destroy more than 600,000 doses of Moderna’s Spikevax Covid-19 vaccine as the doses have reached their expiration date.

However, Moderna CEO Stéphane Bancel told the World Economic Forum in Davos, Switzerland that he’s in the process of throwing 30 million doses in the garbage, exclaiming, “We have a big demand problem.”

More than 500 stakeholders sent comments to the FTC on whether the commission should look further into pharma middlemen, known as PBMs, with many of the commenters calling for more federal oversight.

Similar to the critical open comment period in a deadlocked FTC session last February, pharmacies and pharmacy groups are continuing to call out the lack of transparency among the top 3 PBMs, which control about 80% of the market.